MOU King County

Memorandum of Understanding
Between
Public Health Seattle & King County
Seattle Public Schools
For the Provision of
School-Based Primary Healthcare and Population-based, Preventative Healthcare
BACKGROUND AND MISSION
Since 1989, the City of Seattle and Public Health Seattle & King County have collaborated with
Seattle Public Schools to establish school-based health centers to provide primary healthcare,
including both medical and mental/behavioral health components, and population-based
preventative healthcare in designated schools. A total of 14 school-based health centers now
offer services in all ten comprehensive high schools and selected middle schools.
Public Health Seattle & King County is designated by the City of Seattle as program manager of
funds made available through the 1990, 1997 and 2004 Families and Education Levies and City
of Seattle General Funds. These funds support Seattle Public Schools in their provision of
nursing services and contractor organizations in their operation of school-based health centers.
All activities undertaken in school-based health programs are intended to enhance the health
status of students, thus supporting their academic achievement. This Memorandum of
Understanding effectively supports the educational mission and the public health mission.
PURPOSE OF THIS MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding (MOU) is made and entered into, by and between Public
Health Seattle & King County, hereinafter referred to as PH, and Seattle Public Schools,
hereinafter referred to as SPS.
This MOU is to serve as the operating agreement between the parties for the purpose of
providing and coordinating preventative and primary healthcare services to students through
school-based health centers, school nursing services, and health education activities supported by
the Families and Education Levy.
The parties agree that this MOU is intended to ensure the parties agreement and common
understanding of regulatory guidance and policies, so as to support coordination and integration
efforts of PH and SPS leadership and school-based health and education professionals.
Public Health Seattle & King County and Seattle Public Schools
Provision of School-Based Primary Healthcare and Population-Based, Preventative Healthcare
Page 2
INTENDED RESULTS
SPS and PH share a commitment to building a health services delivery system that increases
access to comprehensive health services through collaboration and formal partnership.
Intended outcomes of system delivery include the following:
1.
2.
3.
4.
5.
More efficient use of resources;

More diversified funding for health services;
Stronger linkages to community partners;
System accountability for system-wide standards and results; and
Local accountability for school-level health plans and strategies.
GENERAL TERMS AND CONDITIONS

The purpose of this MOU is to formalize terms and conditions under which the parties shall work
together to support the provision of healthcare services responsive to individual school
environments and buildings. The MOU sets the framework for coordinated policies in the
following areas:
1.
2.
3.
4.
5.
6.
Separate responsibilities of PH and SPS;

Integrated roles and responsibilities at schools served;
Population-based strategies in outreach, enrollment, health screenings and campaigns;
Space and facilities;
Management of life-threatening emergencies, including privacy considerations; and
Exchange and disclosure of student information, subject to constraints of privacy
considerations and safeguards.
Each party shall defend, indemnify and hold harmless the other for its negligent acts or omission
and those of its officers, employees, agents, or students, howsoever caused.
The parties agree that:
1. The term primary healthcare, as used in this MOU, shall mean medical, nursing, mental
health, drug and alcohol counseling, and health education interventions provided to
individual students in a comprehensive and culturally accessible manner. Primary
healthcare services are provided in partnership with the students family and his /her
medical home or primary care physician whenever possible.
2. The term population-based, preventative healthcare, as used in this MOU, shall mean noncurative interventions provided in a group setting for the purposes of health education
and health promotion, nutrition services, screening for specific health conditions, health
campaigns coordinated across multiple school and community settings, or for prevention
of disease through immunization.
3. The term confidential healthcare, as used in this MOU, shall mean interventions and
services regarding reproductive health care, prevention and treatment of sexually
transmitted disease, treatment for drug or alcohol use, and mental health services for
which state regulation allows provision to minors without parental consent. Confidential
healthcare is part of primary healthcare services and interventions.
Page 3
RESPONSIBILITIES OF THE PARTIES

PH and SPS agree upon the following general framework for separate responsibilities and
contributions to school health programs that are supported by the Families and Education Levy.
Responsibilities of PH
PH agrees to:
1. Provide administrative oversight of school-based health centers and their contractors in
agreed upon schools, managing scope of contracts and performance expectations of
contracting organizations. Health centers will provide the following scope of services:
primary health care; age appropriate reproductive health care including screening and
treatment for sexually transmitted diseases; mental health screening, counseling, case
management, and referral; health education and health promotion; and coordination and
referral for drug/alcohol services.
2. Consult with SPS on an annual basis regarding students health status and school health
program needs, working with SPS to adjust the scope of services accordingly.
3. Monitor quality of care and provide technical assistance in quality improvement processes in
primary healthcare services.
4. Provide administrative oversight of nursing and health education services supported by Levy
and Seattle General Funds, monitoring and managing scope of contracts and performance
expectations.
5. Evaluate and report on program impacts on specific health and academic outcomes,
proposing and managing changes in program design consistent with program goals. Provide
quarterly and annual reports to SPS, the City of Seattle and other interested parties regarding
key aspects, outcomes and impacts of the program.
Responsibilities of SPS
SPS agrees to:
1. Actively promote and integrate school-based health centers into school settings. The
building principal or his/her designee will act as liaison between school and health center
personnel as well as promote and integration school-based health centers into school settings.
2. Provide, hire and supervise nursing staff; participate in the development and implementation
of joint guidelines and procedures that ensure the quality and confidentiality of school-based
nursing services and health center services.
3. Provide space and facilities support for school-based health centers in agreed upon schools,
continuing to maintain rights, responsibilities, and assumed liabilities respective to landlord
and tenant. Leasing and facilities arrangements are described in detail elsewhere in this
MOU.
Page 4
INTEGRATED ROLES AND RESPONSIBILITIES

1. The parties agree that implementation of joint guidelines and written procedures will
most effectively support the integration of clinic services and school nursing services.
a. The parties will jointly pursue the development of written guidelines that guide usual
working relationships in the provision of school-based primary care and populationbased, preventative healthcare.
b. PH will convene and support a working group with appropriate representation from
PH, contracting organizations and SPS nursing staff to guide the development of
shared standards, principles and guidelines.
c. The working group will be convened in February 2005. A document describing core
system-wide standards, principles and guidelines will be substantially completed by
March 2005.
d. System-wide standards, principles and guidelines will be implemented no later than
May 2005.
2. The parties agree that formal data-sharing mechanisms that safeguard the confidentiality
of students are needed so as to conduct evaluation outcome studies and develop a
systematic basis for allocating scarce healthcare resources among student populations.
PH incorporates SPS data into evaluation outcome studies. Studies will be reported to
SPS and will be used to guide changes in program design.
a. SPS and PH will negotiate and execute a data-sharing agreement outlining
procedures, a work plan for specific data elements, and safeguards for data exchange.
b. The data-sharing agreement will be in place by January 2005 and will outline
provisions and a time line for data-sharing during the 2004-05 academic year.
3. The parties agree to jointly maintain coordination of health education services.
a. SPS will convene and support a planning group to review the coordination of shared
resources for school-based health education. The planning group will be convened in
January 2005.
b. A planning document recommending system strategies, resource redeployment and
resource development will be substantially completed by June 1, 2005. The health
education joint work plan will be implemented at the start of the 2005-06 academic
year. The planning process and final work plan will be aligned with all SPS preK
12 Health Education Framework documents.
Page 5
OUTREACH, ENROLLMENT, SCREENING AND HEALTH CAMPAIGNS

Population-based, preventative healthcare strategies include but are not limited to:
1.
2.
3.
4.
Outreach to children and families about accessible health services;

Health screenings (example: vision screenings);
Classroom or school-wide presentations that promote and support changes in behavior;
Outreach campaigns to promote enrollment in school-based health centers and/or health care
coverage; and
5. Health campaigns addressing adolescent risk-taking and health issues (examples: campaigns
focusing on smoking cessation or weight management).
The parties agree to share resources and define collaborative staffing models and protocols as
needed to support population-based strategies that promote healthy outcomes, increase students
access to primary healthcare, and support academic achievement.
The parties further agree that:
1. Coordinated staff support for health campaigns might include activities of school nurses,
health center staff, drug/alcohol specialists and health educators from PH, SPS, and other
agencies.
2. Health center staff participation in population-based strategies should not take precedence
over primary care responsibilities and achievement of program goals in visit productivity
and access.
The parties agree to share resources and define staff support requirements to maximize
enrollment in the school-based health center so as to increase students access to primary
healthcare:
1. A signed parental consent form is required to allow enrollment in health center services
before any student can receive primary healthcare. PH will provide materials that provide
parents with accurate information and appropriate consent options about school-based
health services.
2. Confidential healthcare is exempted from the enrollment policy and may be provided to
students without signed parental consent.
3. PH will make available sample materials to provide parents with accurate information and
appropriate consent options about school-based health services.
4. Distribution of enrollment forms will be incorporated into distribution of SPS education
forms requiring parental review and signature. Distribution will occur at schools, through
school websites, at SPS enrollment centers, and other communication methods.
5. Enrollment staff will request students and/or parent/guardians to sign a release of information
so that health center staff can communicate and coordinate as needed to best serve the
student. Releases are not a requirement for services to be provided to the student.
Page 6
SPACE, FACILITIES AND SERVICES

1. Lease arrangements for health center facilities in the current period in no way constitute a
precedent that rent shall be paid in future years by any programs funded by the Seattle
Families and Education Levy.
2. Lease agreements for health center facilities will be standardized for all sites. Lease
agreements will be executed between SPS and contractor organizations on an annual
basis. Parties to lease agreements continue to maintain rights, responsibilities and
assumed liabilities respective to landlord and tenants.
3. Janitorial services will be provided daily to school-based health centers and the level of
service will be standardized across all clinic sites.
The parties further agree to structure communication around facilities issues:
1.
Contractor organizations may designate a staff person or administrator as the point of

contact to represent clinic interests and participate in problem-solving around issues
concerning facilities and space, janitorial services, and building access. PH will act as
building liaison in lieu of contractor designation.
2.
School principals will designate a building liaison to represent the school administration
in planning and problem solving around issues concerning facilities and space, janitorial
services, and building access.
Page 7
MANAGEMENT OF EMERGENCIES AND PRIVACY CONSIDERATIONS

1. The school nurse is the primary provider of first aid and routine medications to students, and
is among the first line of responders to other school emergencies. If the school nurse is
not available in an urgent or emergent situation, other appropriate school personnel will
respond to the situation.
2. Health center clinicians will follow their contracting organizations direction and procedures
regarding their involvement in responses to urgent or emergent situations. Contracting
organizations will communicate information about their procedures and directions to
clinicians to the school nurse and principal so that these can be taken into account in
emergency response planning.
3. Good Samaritan statutes (RCW 4.24.300) provide immunity from liability for health center
clinicians who render emergency medical treatment in a school setting.
4. The Family Educational Rights and Privacy Act (FERPA) allows for personal health
information in student education records to be released to school-based clinicians in an
emergency or when the information is necessary to protect the health or safety of the
student or other persons.
5. The Health Insurance Portability and Accountability Act (HIPAA) and regulations under the
Washington State Uniform Health Care Information Act allow for personal health
information in health center medical records to be released to school personnel
responding to an emergency when the information is necessary to protect the health or
safety of the student or other persons.
Page 8
EXCHANGE OF STUDENT INFORMATION AND PRIVACY CONSIDERATIONS

Federal and State Regulatory Guidance
The Health Insurance Portability and Accountability Act (HIPAA) and regulations under the
Washington State Uniform Health Care Information Act guide management and protection of
personal health information in medical records kept by school-based health centers. PH, school
based health centers and their contracting organizations, and other Washington State medical
providers are HIPAA covered entities.
The Family Educational Rights and Privacy Act (FERPA) guides management and protection of
personal information in education records maintained by SPS and school nurses. Education
records, including immunization records and other records maintained in the schools
administrative office, are specifically exempted from HIPAA privacy regulations.
Washington State regulations and case law allows minors to independently consent for and
receive the following confidential health services: alcohol/drug abuse treatment, outpatient
mental health treatment, birth control, pregnancy care, STD/HIV diagnosis and testing.
Responsibilities of PH and Contractor Organizations
PH and contracting healthcare organizations will not use or disclose students personal health
information in a manner that would violate the requirements of the HIPAA privacy rule or
Washington state regulations.
The parties agree that personal health information in medical records maintained in school-based
health centers will not be released to school personnel without required minor or parental
consent.
Under HIPPAA and the Uniform Health Care Information Act, PH and contracting healthcare
organizations are permitted to disclose the following without specific parental consent:
1. Personal health information related to a childs immunization status might be provided to
school nurses. School nurses are recognized under HIPAA as limited public health entities
for the limited purpose of receiving immunization-related information to prevent and control
disease.
2. Personal health information may be provided to the school nurse for the express purpose of
the school nurses assessment and treatment of a student.
3. Personal health information may be provided to a medical provider who is providing care and
treatment to the child if it is reasonable to believe that the provider will (i) take appropriate
steps to protect the information and (ii) will not use or disclose the information for any
purpose other than the delivery of health care to the child.
Page 9
PH and its contracting healthcare organizations will:

1.
Use appropriate safeguards to prevent use or disclosure of personal health information other
than as provided in this MOU and consistent with HIPAA privacy rules and state
regulations;
2.
Comply with the Transaction Rule in billing third party payers for clinic encounters;
3.
Report to SPS any use or disclosure not provided for under HIPAA or in this MOU; and
4.
Ensure that contracting healthcare organizations and payers to which the parties may
provide protected health information agree to the same restrictions and conditions as apply
to the parties.
Responsibilities of SPS
SPS will not use or routinely disclose students health status information maintained in
educational records in a manner that would violate the requirements of the Family Educational
Rights and Privacy Act (FERPA) or Washington State statutes regarding provision of confidential
services to minors.
SPS nursing staff may disclose the following to clinic staff without specific parental consent:
1. Personal health information may be released in any emergency when the information may be
necessary to protect the health or safety of the student or other persons.
2. Personal health information related to a child's immunization status might be provided as
school nurses are recognized under HIPAA as limited "public health entities" for the limited
purpose of providing immunization-related information to prevent and control disease.
Page 10
EXECUTION OF MEMORANDUM OF UNDERSTANDING

1.
This MOU is expressly subject to and shall not become effective or binding on any party
hereto until it has been fully executed by all parties.
2.
The MOU shall be binding on all parties, their successors and assigns.
3.
All parties shall review terms and conditions of the MOU during the spring quarter of
each academic school year. Amendments to the MOU negotiated during the spring
quarter affect terms, conditions and binding agreements for the following school year.
4.
The MOU reflects the entire MOU between the parties with respect to the subject matter
hereof and supersedes all other prior oral or written statements, understandings or
correspondence.
5.
The persons signing and executing the MOU have been fully authorized to execute this
agreement and to validly and legally bind PH and SPS to all the terms, performances and
provisions herein set forth.
6.
The term of this MOU shall commence on September 1, 2004, and shall continue for a
period of one year. Thereafter, this MOU shall continue unless otherwise terminated
pursuant to this paragraph. This MOU may be terminated by PH or SPS upon 90 days
written notice.
IN WITNESS WHEREOF, the parties have caused this Memorandum of Understanding to be

executed.
FOR SEATTLE PUBLIC SCHOOLS:
_____________________________
_____________________________
Raj Manhas
Superintendent
Date
FOR PUBLIC HEALTH SEATTLE & KING COUNTY:

_____________________________
_____________________________
Alonzo Plough, Ph.D, M.P.H.

Director
Date
ACKNOWLEDGED BY CITY OF SEATTLE OFFICE FOR EDUCATION:

_____________________________
_____________________________
Holly Miller
Director
Date

MOU King County

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MOU King County

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Memorandum of Understanding

More efficient use of resources;

GENERAL TERMS AND CONDITIONS

Separate responsibilities of PH and SPS;

RESPONSIBILITIES OF THE PARTIES

INTEGRATED ROLES AND RESPONSIBILITIES

OUTREACH, ENROLLMENT, SCREENING AND HEALTH CAMPAIGNS

Outreach to children and families about accessible health services;

SPACE, FACILITIES AND SERVICES

Contractor organizations may designate a staff person or administrator as the point of

MANAGEMENT OF EMERGENCIES AND PRIVACY CONSIDERATIONS

EXCHANGE OF STUDENT INFORMATION AND PRIVACY CONSIDERATIONS

PH and its contracting healthcare organizations will:

EXECUTION OF MEMORANDUM OF UNDERSTANDING

IN WITNESS WHEREOF, the parties have caused this Memorandum of Understanding to be

FOR PUBLIC HEALTH SEATTLE & KING COUNTY:

Alonzo Plough, Ph.D, M.P.H.

ACKNOWLEDGED BY CITY OF SEATTLE OFFICE FOR EDUCATION:

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